Author Of 2 Presentations
P0502 - The Natural Course of Multiple Sclerosis Rewritten: A Population Based Study on Disease Demographics and Progression (ID 758)
Abstract
Background
Over the past few decades there has been an improvement in the rate of disability progression in multiple sclerosis (MS) patients, and most studies relate this evolvement to the introduction of disease modifying therapies. However, several other factors have changed over this period, including access to improved MRI and newer diagnostic criteria
Objectives
To investigate changes in the natural course of MS over time in a near-complete and geographically well-defined population from the south-east of Norway.
Methods
This is a registry-based study. We examined disease progression over two decades and assessed the effect of disease modifying therapies using linear mixed-effect models.
Results
In a cohort of 2097 patients we found a significant improvement in disability as measured by the Expanded Disability Status Scale (EDSS) stratified by age, and the improvement remained significant after adjusting for time on disease modifying medications, gender and progressive MS at onset. The time from disease onset to EDSS 6 in the total cohort was 29.8 years (95% CI 28.5-31.1) and was significantly longer in patients diagnosed after 2006 compared to patients diagnosed before. In addition, we found significant differences between patient demographics, as well as time to EDSS 6 in the near-complete, geographically well-defined population compared to the rest of the cohort from Oslo and its affluent suburbs.
Conclusions
The natural course of MS is improving, but the improvement seen in disease progression in the modern MS patient may have multifaceted explanations. This is supported by our findings of changing population demographics with patients being diagnosed earlier in the disease course, but also at an older age and with less severe disease. Our study underlines the fact that historical cohorts are unsuitable for comparison with modern cohorts in MS studies. We also found significant differences in demographics and time to EDSS 6 between our geographically near-complete population and the rest of the database with the cohort from Oslo and its wealthy suburbs, which means that studies done on incomplete populations should be interpreted with caution.
P0598 - LesionQuant for assessment of MRI in multiple sclerosis- a promising supplement to the visual scan inspection (ID 670)
Abstract
Background
Quantitative measurements of lesion volume, lesion count, distribution of lesions and brain atrophy have a potentially significant value for evaluating disease progression in multiple sclerosis (MS).
Objectives
We wanted to investigate whether utilizing a software designed for evaluating MRI data in MS would be more sensitive and clinically useful compared to the visual neuro-radiological evaluation.
Methods
A group of 56 MS patients (mean age 35 years, 70 % females and 96 % relapsing-remitting MS) was examined with brain MRI one and five years after being diagosed with MS. The T1 and FLAIR brain MRI sequences for all patients were analyzed using the LesionQuant (LQ) software. The resulting LQ output was compared with data from structured visual evaluations of the MRI scans performed by a neuro-radilogist, includning assessements of atrophy and lesion count. Correlations with clinical tests, like the timed 25- foot walk test (T25-FW), were performed to explore additional value of LQ analyses compared to visual assessments.
Results
Lesion count assessments by LQ and by the neuro-radiologist were significantly correlated one year (cor=0.92, p=2.2x10¯16) and five years (cor=0.84, p=2.7x10¯16) after diagnosis. LQ detected a reduction in whole brain percentile >10 in 10 patients across the time-points, whereas the neuro-radiologist assessment identified six of these. The neuro-radiologist additionally identified five patients with increased atrophy in the follow-up period, all of them displayed decreasing low whole brain percentiles (median 11, range 8-28) in the LQ analysis. A significant positive correlation was identified between lesion volume measured by LQ and test performance of T25-FW both at one year (t=3.08, p=3.2x10¯3) and five years (t=3.72, p=4.8x10¯4) after diagnosis, while we found no association between visual inspection and the clinical tests.
Conclusions
For the number of MS lesions at both time-points, we demonstrated strong correlations between the assessments done by LQ and the neuro-radilogist. Lesion volume evaluated with LQ correlated with T25-FW performance. LQ-analyses were more sensitive in capturing brain atrophy than the visual neuro-radiological evaluation. In conclusion, LQ seems like a promising supplement to the evaluation performed by neuro-radiologists, providing an automated tool for evaluating lesions and brain volume in MS patiens in both a longitudinal and cross-sectional setting.